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Mental Pain and Suicidal Tendencies in Sexual and

Physical Abuse Victims

Inbar Kremer, Israel Orbach & Tova Rosenbloom

To cite this article: Inbar Kremer, Israel Orbach & Tova Rosenbloom (2016): Mental Pain and
Suicidal Tendencies in Sexual and Physical Abuse Victims, Archives of Suicide Research, DOI:
10.1080/13811118.2016.1175394

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 Archives of Suicide Research, 0:1–15, 2016
Copyright # International Academy for Suicide Research
ISSN: 1381-1118 print=1543-6136 online
DOI: 10.1080/13811118.2016.1175394

Mental Pain and Suicidal

Tendencies in Sexual and
Physical Abuse Victims
Inbar Kremer, Israel Orbach, and Tova Rosenbloom

We examine differential effects of mental pain and suicidal tendencies in female

victims who have been sexually and physically abused, hypothesizing that sexual
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abuse victims report more mental pain and suicidal tendencies than physical abuse
victims. A group of 98 women completed questionnaires that measured mental pain,
suicidal tendencies and thoughts, and demographic details. Sexual abuse victims
suffered more mental pain than physical abuse victims while the physical abuse
victims demonstrated more repulsion by life than sexual abuse victims. Only sexual
abuse victims demonstrated less attraction to life and only physical abuse victims
showed more attraction to death.

Keywords mental pain, physical abuse, sexual abuse, suicidal tendencies

This study was undertaken to shed light on
the differences in mental pain and suicidal
tendencies between sexual abuse victims
and physical abuse victims in Israeli
women. Many studies in this domain have
focused on sexual abuse and physical abuse
as one unit and many common features
have been found (Franko & Keel, 2006;
Ullman & Brecklin, 2003). However, sev-
eral studies have examined the differential
effects of each form of abuse. These stu-
dies revealed that sexual abuse is perceived
as having more severe repercussions than
physical abuse (for example, Anne, Nayak,
Korcha, & Greenfield, 2011). In this vein,
Kremer, Orbach, and Rosenbloom (2013)
found that victims of sexual abuse reported
more body image injury than victims of
physical abuse. The current study is aimed
at expanding the knowledge about the dif-
ference among these groups of victims—
those who suffered physical abuse, sexual
abuse, and both—in regard to mental pain
and suicidal tendencies. We hypothesized
that sexual abuse victims suffer more
severe mental pain as well as more suicidal
thoughts and tendencies than physical
abuse victims. The literature review will
focus on various types of abuse, mental
pain, and suicidality and the association
among them. One of the unique contribu-
tions of the current study is to test the
difference between sexual and physical
abuse with regard to a new concept yet
being examined: mental pain.
Literature Review
Abuse of women and children is a
complex and multifaceted phenomenon as
reflected through its many diverse defini-
tions. Physical abuse includes beating,
slapping, kicking, burns, threats with a cold
weapon (like a knife), destruction of a
loved object or pet and others (Straus,

1
 Mental Pain and Suicidal Tendencies in Abuse Victims
1988). Sexual abuse includes rape, forced
intercourse, unwanted sexual acts that do
not include penetration, threat of bodily
harm in the case of refusal of sex, and
spousal rape (ibid.; Russell, 1984).
In most cases, both sexual and physical
abuse are perpetrated by a family member
or another person who is known to the
victim. Sexual and physical abuse commit-
ted by a family member are the most
traumatizing forms of abuse of women,
who are regarded as an easy target of abuse
(Mackinnon & James, 1992). The few stu-
dies published in Israel in regard to abuse
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reveal that the prevalence of sexual and
physical abuse is similar to other Western
countries (Schein et al., 2000; Tzionit &
Kedman, 2001): Seven percent of women
suffer sexual abuse and 10% suffer physical
abuse (Korman, 2000; Pereda, Guilera,
Forns, & Gomez-Benito, 2009).
Research and clinical literature demon-
strate that women who undergo physical or
sexual abuse have a history of more suicide
attempts and self-inflicted injury than
women who were not victims of violence
(Etzel, 2006; MaKeganet, Neale, &
Robertson, 2005; Maniglio, 2011) a higher
tendency to develop eating disorders
(Franko & Keel, 2006; Treuer, Koperdak,
Rozsa, & Furedi, 2005), a higher frequency
of addictive drug use (Segal, 2001; Somer,
2003; Zickler, 2002), somatic disorders
(Ullman & Brecklin, 2003) and depression
(Csoboth, Birkas, & Purebl, 2005), more
dissociative symptoms (Somer, 2003; Sta
& Elaine, 2005) and signs of PTSD (Filipas
& Ullman, 2006; Sharhabani-Arzy, Amir,
Kotler, & Liran, 2003). Moreover, they
suffer from a negative body image and
low self-esteem (Eubanks, Kenkel, &
Gardner, 2006) as well as more borderline
personality disorders (Lobbestael, Arntz,
& Bernstein, 2010) than women with no
history of abuse.
Several studies that examined the
differential effects of sexual abuse versus
physical abuse point to the existence of
2 VOLUME 0  NUMBER 0  2016
clearly different effects of each kind of
abuse. They found that women with a
history of sexual abuse demonstrated sig-
nificantly more posttraumatic symptoms
(Amstadter & Vernon, 2008), more
unexplained medical symptoms and more
symptoms of anxiety, avoidance, and dis-
association (Walker, Gelfand, Gelfand,
Koss, & Katon, 1995) than women who
suffered physical abuse.
Sexual and physical abuse often occur
in various phases during victims’ lifetimes
and both forms together cause more
trauma than just one form of abuse
(Bonomi, Anderson, Rivara, & Thompson,
2007). These victims show a higher
propensity to drug use, more suicide
attempts, a greater feeling of helplessness
in their relationships (Wingood,
Diclemente, & Raj, 2000, in Tzionit &
Kedman, 2001), and more severe PTSD
symptoms (Hetzel & McCanne, 2005) than
women who suffered physical abuse only.
Therefore, sexual abuse, physical abuse,
and both sexual and physical abuse should
be referred to as three separate phenom-
ena, each with its own nature and severity.
In view of this, we examined those factors
associated with the differential effects of
sexual abuse, physical abuse, and concur-
rent sexual=physical abuse. First, we
examined the differential effects of each
form of abuse in terms of victims’ mental
pain, a variable that had yet to be
researched in regard to abuse. Second, the
differential effects of each form of abuse
were examined in regard to suicidality
(attraction to=repulsion by life and death)
and frequency of suicidal thoughts.
Baumeister (1990) describes mental
pain as disappointment in oneself and
an exaggerated sense of negative self-
awareness that stems from an increasing
incongruity between one’s actual and one’s
ideal self. When mental pain becomes
unbearable, some people try to escape it
by attempting suicide (Shneidman, 1996).
Orbach and Mikulincer (2001) proposed

that mental pain could be most accurately
described as the broad range of subjective
experiences characterized by a perception
of the negative changes in the self and its
function, along with intense negative
emotions and negative cognitions. These
negative changes manifest themselves as
negative changes in self-image and self-
function. They developed a mental pain
scale (Orbach-Mikulincer Mental Pain -
OMMP) that assesses loss of control,
irreversibility of pain, emotional flooding,
narcissistic wounds, internal alienation and
estrangement, cognitive difficulties, empti-
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ness and social distancing. According to
Orbach and Mikulincer (2001), suicidal
individuals suffer from more mental pain
than non-suicidal people. Also, optimism
and meaning of life inversely correlate to
most aspects of mental pain. With this in
mind, one of the key goals of this study
was to examine the differences in mental
pain experiences in sexual abuse victims
versus physical abuse victims, an issue
previously not investigated.
Studies and theories regarding mental
pain declare that there is a correlation
between the experience of mental pain
and suicidality. Shneidman (1996) states
that unbearable mental pain and anguish
are common in all suicide cases: those
who attempt suicide as well as those who
succeed. He maintained that when the pain
increases to its most intense level and when
no future changes can be expected, the sui-
cidal person will seek a way to escape it by
ending her or his own life. Orbach (1987)
proposed a phenomenological model to
explain suicidal behavior with his design
of an attraction to=repulsion by life=death
scale. Suicidal behavior stems from funda-
mental conflicts between these attitudes.
Attraction to life expresses one’s pleasure
and satisfaction from life. Repulsion by life
is a self-destructive force that reflects the
pain and suffering one may experience
(loss, sexual and physical abuse, rejection,
unresolved problems, a tendency for
ARCHIVES OF SUICIDE RESEARCH
I. Kremer et al.
self-blame). Attraction to death expresses
the belief that death is a form of physical
or spiritual existence preferable to life.
Repulsion by death is founded on the percep-
tion that death is an irreversible condition
of finality and nothingness.
Relevant research literature reveals a
correlation between sexual and=or physical
abuse and suicidal behavior. Studies show
that the experience of physical abuse or
sexual abuse in childhood constitute a
clear and significant predictor of suicide
attempts or self-harmful behavior in adult-
hood (for example, Brodsky & Stanley,
2008).
Rationale and Hypotheses
In summary, the common effects and
repercussions of sexual and physical abuse
have been subjected to extensive theoreti-
cal study and research but the differential
effects of each form of abuse remain lar-
gely unaddressed. The research reviewed
here reveals that the handful of studies that
indeed examined the differential effects of
each abuse group show that there are dif-
ferences in the way each form of abuse
affects its victims (Amstadter & Vernon,
2008; Danielson, de Arellano, Kilpatrick,
Saunders, & Resnick, 2005).
For example, Kremer et al. (2013)
revealed that sexual abuse victims reported
lower body maintenance and protection
than victims of physical abuse and showed
greater injury to body sensitivity and con-
trol. In line with these findings, this study
is focused on the suicidal tendencies and
thoughts of sexual and physical abuse vic-
tims. Also, the differences between the
groups were examined in terms of mental
pain. It should be noted that the experience
of mental pain—an in-depth look into the
internal world of pain suffered by victims—
has never been studied. This study focused
on the trauma inflicted by long-term and
continuous sexual and physical abuse
3
 Mental Pain and Suicidal Tendencies in Abuse Victims
and not on one-time events, based on
Herman’s distinction of continuous versus
one-time abuse (1992). Also, most of the
perpetrators of these kinds of abuse were
familiar to the victims through family ties
rather than being strangers (Straus, 1988).
Another purpose of this study was the
clear delineation of the four groups: sexual
abuse victims, physical abuse victims, vic-
tims of both sexual and physical abuse,
and women with no history of abuse.
Research Hypotheses
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H1: Women who have undergone
sexual and=or physical abuse
will report more mental pain
than women with no history of
abuse.
H2: The measure and severity of
mental pain will differ among
the various groups; victims of
both sexual and physical abuse
suffer more severe mental pain
than sexual abuse victims and
they, in turn, suffer more mental
pain than women who suffered
only physical abuse.
H3: Women who have undergone
sexual and=or physical abuse
will report more severe suicidal
thoughts and tendencies com-
pared with women with no his-
tory of abuse.
H4: The severity of suicidal thoughts
and tendencies will differ among
the various abuse groups with the
assumption being that women
who were victims of both forms
of abuse will demonstrate more
severe suicidal thoughts and ten-
dencies compared to sexual
abuse victims and they, in turn,
will suffer more severe suicidal
thoughts and tendencies than
physical abuse victims.
4 VOLUME 0  NUMBER 0  2016
METHOD
Participants
Women who suffered sexual abuse and
physical abuse were selected using non-
probability sampling of the target sample.
This decision was made due to the difficult-
ies in reaching this target population which
typically suffers severe emotional trauma in
all intimate, taboo matters in addition to
dealing with the difficulties in persuading
them to participate in the study. Relevant
research literature includes circumstances
where this method of non-randomized
selection is appropriate, such as cases
where the target population is very specific
and difficult to sample (Patton, 1990). It is
important to note that recruitment of
physical as well as sexual abuse victims is
especially difficult. There is evidence that
only 15% of these victims report to any
agency about the abuse (Thomisson,
1996). Therefore, a representative sampling
of these victims is almost impossible. This
research was conducted as part of a larger
project, and other variables examined have
been documented in another article (Kre-
mer et al., 2013). In total, 98 women parti-
cipated, 76 of whom met the sampling
criteria, including a history of long term
and continuous abuse. The sample inclu-
ded only women who were abused by a
person familiar to the victim, mostly a fam-
ily member, and excluded abuse committed
by strangers.
Another eleven women (11%) were
not included in the final sample as they
did not meet the study criteria which exam-
ined only those victims of long-term and
continuous abuse. The four study groups
consisted of: (1) 28 women who suffered
both sexual and physical abuse, (2) 25
women who suffered only sexual abuse,
(3) 23 women who suffered only physical
abuse, and (4) 22 women with no history
of any abuse who served as the control
 I. Kremer et al.

TABLE 1. Distribution of Study Participants According to Personal Information

Personal Control Sexual Physical Sexual  Physical

Information Values N ¼ 22 N ¼ 25 N ¼ 23 N ¼ 28

Marital status Single N 10 16 9 12

% 45.5 64 39.1 42.9
Married N 11 7 9 6
% 50 28 39.1 21.4
Divorced N 1 2 5 10
% 4.5 8 21.7 35.7
Employment Not working N 5 8 9 12
% 22.7 32 39.1 42.8
Part-time N 9 7 5 9
% 40.9 28 21.7 32.1
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Full-time N 10 9 7
% 36.4 40 39.1 25

group. All of the women were adults over
the age of 18 (M ¼ 33, SD ¼ 11) with 89
of them (91%) native-born Israelis and 9
(9%) born elsewhere.
In order to compare the categorical
demographic variables (marital status and
employment) v2 analyses were conducted.
In addition, in order to compare successive
demographic variables (age and education),
one-way ANOVA analyses were conducted.
The results of these analyses are pre-
sented in Table 1 and Table 2.
The results of v2 analysis comparing
the four groups showed a significant differ-
ence only in reference to marital status
(v2(6) ¼ 13.8, p < .05): The group of both
sexual and physical abuse consisted of
more divorced women than the other
groups. In terms of employment, the distri-
bution was quite even among women
working full-time, part-time or not
working.
As seen in Table 2 there is a significant
difference between groups in regard to the
age variable. When a further analysis
(Scheffé) was conducted to determine the
source of these variations, results showed
a significant difference between the control
group and the physical abuse group in
terms of age variable with physical abuse

TABLE 2. Means and Standard Deviations: Age and Education According to Study Groups

Groups
Measurements Control Sexual Physical Sexual  Physical F(3,94)

Age
M 27.66 30.76 36.43 35.25 3.5
SD 8.14 8.17 12.47 12.04
Education
M 14.04 14.24 14.08 13.44 .38
SD 2.73 2.75 3.43 2.84

Note.  p < .05.

ARCHIVES OF SUICIDE RESEARCH 5

 Mental Pain and Suicidal Tendencies in Abuse Victims
victims being older. In contrast, no signifi-
cant difference was found between the
various groups in education (the general
mean was approximately14 years of
education).
Instruments
Personal Information Questionnaire (Demographic
Details). This questionnaire included age,
ethnicity, education, employment, religion,
and marital status. Furthermore, this ques-
tionnaire included information about the
kind of abuse the women experienced over
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their lifetime: sexual abuse (yes= no) or
physical abuse (yes= no). Based on this
information the women were classified into
one of the four abuse groups. In addition,
there was a question about whether the
abuse was a one-time act or was long-term
and continuous (more than one-time
event).
Multi-Attitude Suicidal Tendencies Scale. The
Multi-Attitude Suicidal Tendencies Scale
(Orbach et al., 1991) is a 30-item question-
naire that examines suicidal tendencies
rated on a scale of 1–5 (1 ¼ disagree
completely; 5 ¼ agree very much) divided into
four attitudes: attraction to life (for
example: ‘‘I enjoy doing many things’’);
repulsion by life (for example: ‘‘Life seems
to me a long ongoing struggle’’); attraction
to death (for example: ‘‘Death could be a
positive change’’); and repulsion by death
(for example: ‘‘I fear death because of the
decomposition and burial of the body’’).
The final score of each factor was calcu-
lated independently as the average score
of each item in that factor. A high score
could mean high attraction to life, a high
repulsion by life, high attraction to death,
and high repulsion by death, so that high
attraction to life and high repulsion by
death reflect a low tendency to suicidality
whereas a high repulsion by life and high
attraction to death reflect a high tendency
6 VOLUME 0  NUMBER 0  2016
to suicidality. The internal consistency of
the questionnaire, as based on previous
studies: a ¼ .83 for ‘‘Attraction to Life’’ fac-
tor; a ¼ .76 for ‘‘Repulsion by Life’’ factor;
a ¼ .76 for ‘‘Attraction to Death’’; and
a ¼ 0.8 for ‘‘Repulsion by Death’’ factor.
Overall internal consistency of the ques-
tionnaire is a ¼ 0.92. Internal consistency
as measured in the current study is
a ¼ 0.88 for ‘‘Attraction to Life’’, a ¼ 0.81
for ‘‘Repulsion by Life’’, a ¼ 0.75 for
‘‘Attraction to Death’’ and a ¼ 0.91 for
‘‘Repulsion by Death.’’
Suicidal Ideation Questionnaire. The Suicidal
Ideation Questionnaire (SIQ) (Reynolds,
1988) is a 30-item self-report questionnaire
designed to examine adult populations and
assess the frequency of suicidal thoughts.
The participant is asked to rate each item
on a scale of 0–6 (0 ¼ Never had such
thoughts, 6 ¼ Think about it on an almost daily
basis). The final score is calculated as the
sum of rated items with 180 as the maxi-
mum score. Internal consistency of the
questionnaire as based on previous studies
ranges 0.52-0.70. Internal consistency of
current study is a ¼ 0.95.
Mental Pain Scale. The Mental Pain Scale
(OMMP: Orbach & Mikulincer, 2001)is a
45-item questionnaire rated on a scale of
1–5 (1 ¼ Not true at all; 5 ¼ Very true). These
items are divided into nine factors: 1) irre-
versibility of pain (ex., ‘‘My life has changed
irrevocably’’ a ¼ 0.81); 2) loss of control
(ex., ‘‘I cannot control what is happening
inside me’’ a ¼ 0.89); 3) narcissistic wounds
(ex., ‘‘No one is interested in me’’ a ¼
0.88); 4) emotional flooding (ex., ‘‘I am in
emotional turmoil’’ a ¼ 0.93); 5) emotional
freezing (ex., ‘‘I feel paralyzed’’ a ¼ 0.84);
6) internal alienation and estrangement
(ex., ‘‘I feel unreal’’ a ¼ 0.83); 7) cognitive
difficulties (ex., ‘‘I cannot concentrate’’
a ¼ 0.71); 8) emptiness (ex., ‘‘I don’t feel
like doing anything’’ a ¼ 0.84); and 9) social
distancing (ex., ‘‘I need support from

others’’ a ¼ 0.76). There are 3–10 items in
each factor and factor loadings of each
are in the 0.40–0.92 range. Correlations
between elements of mental pain were
measured and a significant positive corre-
lation was found (r ¼ 0.58–0.86). There-
fore, a general mental pain score was
calculated that includes the mean score
on all 45 items (a ¼ .98 in the present
study).
Procedure
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Most of the women who participated
in the study answered an advertisement
which was published on university cam-
puses and in various magazines. A very
small number of women were referred by
the Rape Crisis Centers and Family
Violence Assistance Centers, due to the
nominal cooperation on their part. The
control group was comprised of com-
munity members (by publishing advertise-
ments in various universities and through
acquaintances who passed out question-
naires to people from their workplaces).
The participants who volunteered
contacted the researcher and received
instructions about how to fill out the ques-
tionnaires on their own. In the preliminary
phone call with a potential participant, the
experimenter ensured that relevant terms,
such as physical or sexual abuse, were
clearly understood. The participants sent
back the questionnaires by post in a return
envelope that was included in the question-
naire package. Control respondents also
received their questionnaires from the
researcher. As the members of the study
group, they sent their completed question-
naires by post in the supplied return
envelope. The participants were informed
that all the details they had reported will
be kept confidential.
The first page of the questionnaire
contained a short explanation of the pur-
pose of the study, and a consent form.
ARCHIVES OF SUICIDE RESEARCH
I. Kremer et al.
The percentage of returned questionnaires
was around 90%. None of the participants
was compensated for the time devoted to
the study.
RESULTS
In order to examine the differences
between the measures of the various study
groups, a 2  2 ANOVA was conducted.
The independent variables were sexual
abuse (yes=no) and physical abuse (yes=
no) and the interaction between them.
The dependent variables were mental pain,
suicidal thoughts, and suicidal tendencies.
Further, in order to clarify possible interac-
tions, Simple Effects Tests were conduc-
ted. Since there was an age difference
between the study groups, an additional
2  2 ANCOVA was conducted, with age
as a covariate. There were no differences
between the two sets of analyses.
Mental Pain
The results of the 2  2 ANOVA are
presented in Table 3.
The analysis of the questionnaire
scores revealed a statistically significant
difference (main effect) between levels of
mental pain of women who suffered sexual
abuse and of women who had not suffered
this form of abuse, so that sexual abuse vic-
tims experience more severe measures of
mental pain (M ¼ 3.3, SD ¼ .10) than
women who have not suffered sexual abuse
(M ¼ 2.61, SD ¼ .11).
The ANOVA analysis also revealed a
significant difference when comparing
women who had suffered physical abuse
and those who had not. Physical abuse vic-
tims reported greater measures of mental
pain (M ¼ 3.22, SD ¼ .10) than women who
had not suffered physical abuse (M ¼ 2.68,
SD ¼ .11).
Also, a comparison of Eta2 of mental
pain of sexual abuse victims and physical
7
 Mental Pain and Suicidal Tendencies in Abuse Victims

TABLE 3. Analysis of Variance of Mental Pain Across the Study Groups

Source Df SS MS F Eta2

Sexual. Abuse 1 11.55 11.55 21.08 .18

Physical. Abuse 1 7.05 7.05 12.87 .12
Sex phy 1 4.09 4.09 7.47 .07
Within groups 94 51.49 .55

Note.  p < .05 

p < .01 
p < .001.

abuse victims shows that sexual abuse vic-
tims suffer more severe mental pain than
physical abuse victims.
In addition, the ANOVA analysis
revealed a significant interaction between
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abuse victims versus women who did
not suffer sexual abuse while comparing
physical abuse victims with women who
did not suffer physical abuse revealed a sig-
nificant difference in mental pain among

sexual and physical abuse in regard to men-
tal pain (see Figure 1).
Inspection of Figure 1 reveals that
among sexual abuse victims, there is no sig-
nificant difference between those that also
suffered physical abuse and those that did
not. Conversely, among women with no his-
tory of sexual abuse, those that were physical
abuse victims experienced more severe men-
tal pain than women with no background of
physical abuse. The measure of mental pain
among women with no history of sexual
and=or physical abuse is less severe in com-
parison with sexual and=or physical abuse
victims. One should note that simple effects
analyses conducted separately for sexual
women who did not suffer sexual abuse
F(1,43) ¼ 28.531, P < .001, Eta2 ¼ .399.
However, no significant difference in mental
pain was found among sexual abuse victims
F(1,51) ¼ .33, P > .05.
Suicidal Tendencies
Attraction to Life. The results of the 2 x 2
ANOVA are presented in Table 4.
The analysis of the questionnaire
scores revealed only a statistically signifi-
cant difference (main effect) between levels
of attraction to life of women who suffered
sexual abuse and of women who had not

FIGURE 1. Means of mental pain across the study groups.

8 VOLUME 0  NUMBER 0  2016

 I. Kremer et al.

TABLE 4. Analysis of Variance of Attraction to Life Across the Study Groups

Source Df SS MS F Eta2

Sexual abuse 1 1.99 1.99 4.44 .05

Physical abuse 1 1.65 1.65 3.69 .04
Sex phy 1 1.23 1.23 2.75 .03
Within groups 94 42.08 .45

Note.  p < .05 

p < .01 
p < .001.

suffered this form of abuse, so that sexual
abuse victims demonstrate less attraction
to life (M ¼ 3.77, SD ¼ .09) than women
who have not suffered sexual abuse
(M ¼ 4.06, SD ¼ .10). No significant main
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who suffered physical abuse and those that
did not in repulsion by life. Physical abuse
victims demonstrate more repulsion by life
(M ¼ 2.73, SD ¼ .10) than women with no
history of physical abuse (M ¼ 2.02, SD ¼

effect was found between physically abused
women and women who had not suffered
physical abuse in regard to attraction to life.
Also no significant interaction was found
between sexual and physical abuse in
regard to attraction to life. It is clear that
in attraction-to-life measurements, only
sexual abuse victims show significantly less
attraction to life.
Repulsion by Life. The results of the 2  2
ANOVA are presented in Table 5
The analysis of the questionnaire
scores revealed a statistically significant dif-
ference (main effect) between levels of
repulsion by life of women who suffered
sexual abuse and of women who had not
suffered this form of abuse, so that sexual
abuse victims experience more repulsion
by life (M ¼ 2.62, SD ¼ .10) compared with
women with no history of sexual abuse
(M ¼ 2.14, SD ¼ .10). In addition, a signifi-
cant difference was found among women
.10). No significant interaction was found
between sexual and physical abuse in
regard to repulsion by life. Also, an Eta2
comparison of sexual abuse victims and
physical abuse victims in repulsion by life
shows that physical abuse victims demon-
strate more repulsion by life than sexual
abuse victims.
Attraction to Death. The results of the
2  2 ANOVA are presented in Table 6
The analysis of the questionnaire
scores revealed only a statistically signifi-
cant difference (main effect) between levels
of attraction to death of women who suf-
fered physical abuse and of women who
had not suffered this form of abuse, so that
physical abuse victims demonstrate more
attraction to death (M ¼ 2.58, SD ¼ .10)
than women who have not suffered physi-
cal abuse (M ¼ 2.19, SD ¼ .11). No signifi-
cant main effect was found between
sexually abused women and women who

TABLE 5. Analysis of Variance of Repulsion by Life Across the Study Groups

Source Df SS MS F Eta2

Sexual abuse 1 5.56 5.56 11.20 .11

Physical abuse 1 12.14 12.14 24.47 .21
Sex phy 1 .60 .60 1.20 .01
Within groups 94 46.62 .50

Note.  p < .05 

p < .01 
p < .001.

ARCHIVES OF SUICIDE RESEARCH 9

 Mental Pain and Suicidal Tendencies in Abuse Victims

TABLE 6. Analysis of Variance of Attraction to Death Across the Study Groups

Source Df SS MS F Eta2

Sexual abuse 1 1.83 1.83 3.37 .03

Physical abuse 1 3.61 3.61 6.34 .07
Sex phy 1 .02 .02 .04 .00
Within groups 94 51.07 .54

Note.  p < .05 

p < .01 
p < .001.

had not been sexually abused in regard to
attraction to death. Also no significant
interaction was found between sexual and
physical abuse in regard to attraction to
death. It is clear that in attraction-to-death
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The analysis of the questionnaire
scores revealed a statistically significant dif-
ference (main effect) between women who
suffered sexual abuse and those that did
not. Sexual abuse victims report far greater

measurements, only physical abuse victims frequency of suicidal thoughts (M ¼ .99,

show significantly more attraction to death.
Repulsion by Death. The results of the 2  2
ANOVA are presented in Table 7
The analysis of the questionnaire
scores revealed no significant main effects
and no significant interaction in regard to
repulsion by death.
Suicidal Thoughts. The results of the 2  2
ANOVA are presented in Table 8
SD ¼ .08) than women who were not
sexually abused (M ¼ .47, SD ¼ .09). A sig-
nificant difference was also found between
women who suffered physical abuse and
those that did not. Physical abuse victims
reported a higher frequency of suicidal
thoughts (M ¼ .95, SD ¼ .09) compared to
women who had never suffered physical
abuse (M ¼ .50, SD ¼ .09). Conversely, no
significant interaction was found. Further-
more, an Eta2 comparison of sexual abuse
victims and physical abuse victims reveals

TABLE 7. Analysis of Variance of Repulsion by Death Across the Study Groups

Source Df SS MS F Eta2

Sexual abuse 1 .71 .71 .63 .01

Physical abuse 1 .29 .29 .26 .00
Sex phy 1 .01 .01 .01 .00
Within groups 94 105.62 1.12

Note.  p < .05 

p < .01 
p < .001.

TABLE 8. Analysis of Variance of Suicidal Thoughts Across the Study Groups

Source Df SS MS F Eta2

Sexual abuse 1 6.40 6.40 16.95 .15

Physical abuse 1 4.97 4.97 13.16 .12
Sex phy 1 .34 .34 .91 .01
Within groups 94 35.47 .38

Note.  p < .05 

p < .01 
p < .001.

10 VOLUME 0  NUMBER 0  2016


no significant difference between the
groups in the frequency of suicidal thoughts.
DISCUSSION
This study confirms that in regard to most
study variables, women who underwent
sexual or physical abuse indeed suffer
greater injury than women with no history
of abuse. Findings also indicate that sexual
abuse victims report more severe mental
pain compared with physical abuse victims.
On the other hand, physical abuse victims
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report more repulsion by life and more
attraction to death compared with sexual
abuse victims. No significant difference
was found between physical and sexual
abuse victims in terms of frequency of sui-
cidal thoughts. Thus, sexual abuse and
physical abuse should be examined discre-
tely as each may have differential effects
on the mental health of their victims.
As in previous studies (Bar Karlin,
1999; Waldinger, Swett, Frank, & Miller,
1994) no significant difference in mental
pain and suicidal thoughts or tendencies
between women who suffered sexual abuse
and women who suffered both sexual and
physical abuse were found. It seems that
for women who experienced sexual abuse,
their mental pain was so high that the
addition of physical abuse added no more
to their mental pain.
Findings also confirm that women who
undergo sexual and=or physical abuse
experience more severe mental pain than
women with no history of abuse, and that
sexual abuse victims (only sexual or sexual
and physical) suffer more severe mental
pain than physical abuse victims. The defi-
nition of mental pain presented by Orbach
and Mikulincer (2001) indicates that one
element of mental pain is the feeling of loss
of control. Battered women are usually in a
relationship with a chosen partner in whom
they perceives positive qualities. However,
sexual abuse often occurs when the
ARCHIVES OF SUICIDE RESEARCH
I. Kremer et al.
relationship with the perpetrator has been
forced or coerced on the survivor through
acquaintance or family ties, so there is less
of a sense of control over events and a
stronger feeling of helplessness (Irons &
Schneider, 1997; Van Buskirk & Cole,
1983). Perhaps this is the reason that
women who undergo sexual abuse experi-
ence much more severe measures of mental
pain than physical abuse survivors. In
future research it is recommended to test
this notion.
In addition, this study confirms that
the experience of mental pain is significant
and typical of abuse victims and is there-
fore felt more intensely by them than by
women with no history of abuse. As this
area of research is still in its infancy and,
to date, this study is the only one of its kind
examining the differences between various
forms of abuse in relation to mental pain,
there is need to expand and deepen this
investigation in future research.
According to Herman (1992), abuse can
damage the normal regulation of affective
situations due to anxiety, panic, and
despair. It is not easy to cope with such
extreme situations in conventional ways
but often the victim copes by using patho-
logical relaxation mechanisms, such as
self-mutilation. This action can cause relief
since physical pain is preferable to mental
pain (Hicks & Hinck, 2008). Therefore
the distinction between self-mutilation
and suicidal behavior is crucial at this point.
It can be assumed that women who were
victims of sexual abuse mutilate their body
for purposes of self-relaxation rather than
for purposefully putting an end to their
lives. Hicks and Hinck (2008) found in
their research that risk factors for self-
mutilation may be White race, adolescent
age, female sex, and history of sexual abuse.
In contrast, according to the current
research, women who were victims of
physical abuse and experience more repul-
sion by life and more attraction to death
mutilate their body for the purpose of
11
 Mental Pain and Suicidal Tendencies in Abuse Victims
putting an end to their lives. This issue
should be examined in the future research.
No differences in suicidal thoughts
were found between women who suffered
sexual and=or physical abuse, a result that
replicates previous research (Ystgaard,
Hestetun, Loeb, & Mehlum, 2004). One
possible reason for this could be in the
explanation of the cognitive perspective
of suicidality (Baumeister, 1990). Accord-
ing to this approach, one of the thought
patterns that shapes the emotions and
experiences of the suicidal person is a nega-
tive attitude to self. A typical characteristic
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of suicidal people is a tendency to have
negative assumptions about themselves
that lead them to interpret various experi-
ences as proof of their worthlessness,
incapability, and measure of self-blame.
This negative attitude to self can be seen
in both sexual abuse victims and physical
abuse victims. They blame themselves for
the abuse, they internalize the perpetrators’
attitudes and so feel a lowering of self-
esteem (Herman, 1992). This explanation
supports the claim that women who suffer
sexual and=or physical abuse have more
negative attitudes to the self, and so among
these two groups a similar pattern of suici-
dal behavior is evident. This issue is worthy
of future examination.
Practical Implications
The findings of this study have impor-
tant practical implications on the thera-
peutic level. The current study maintains
that as both forms of abuse produce both
common and individual symptoms in the
victims, then the clear classification of the
repercussions could help focus treatment
on the particular characteristics of each
injury and the specific symptoms unique
to each group (in line with Briere & Jordan,
2004). The findings of this study show that
women who suffered sexual abuse report
more severe mental pain compared with
12 VOLUME 0  NUMBER 0  2016
physical abuse victims. Kremer et al. (2013)
found that sexual abuse victims demonstra-
ted less body maintenance and body
protection, more injury to their sense of
body control, and were less attentive to
body clues. These women also had more
negative and distorted physical sensations
and a feeling their body boundaries were
unclear to them. In clinical treatment with
sexually abused women, it is recommended
by the authors to focus on coping with the
extensive damage to body image that is the
consequence of this abuse. Treatment
should help women maintain and nurture
their body, to cope with the rejection they
feel in regard to it, to deal with the dis-
torted body perceptions they have, and
help them restore the sense of ownership
and control they should have over their
body.
According to the current study,
psychological treatment should also be able
to reduce the mental pain they experience
and help them to rehabilitate the feelings
of control of their lives the trust in them-
selves and in other people.
In contrast, physical abuse victims
report more repulsion by life and more
attraction to death compared with sexual
abuse victims. Thus, we suggest that a dif-
ferent approach is needed in the treatment
of women who suffered physical abuse. A
more effective treatment could be to assist
them in finding meaning in their lives and
new sources for attraction to living.
Limitations and Further Research
There are number of methodological
remarks that should be taken into consider-
ation. Data collection was very complicated
due to the sensitivity involved in it. Thus,
we did not relate to personal details such
as severity and duration of the abuse.
Future research should elaborate this point.
Most of the study data were collected from
women who answered advertisements. This

method of data collection includes only a
partial population segment of women
who have suffered abuse and so generaliz-
ability of this study is limited. Even though
the sampling was not representative, the
current study provides unique evidence of
the existence of differential implications
of physical versus sexual abuse. In addition,
we found a significant difference in the
age of participants who experience physical
abuse compared to those who had not.
The issue of the participants’ age should
be taken in consideration in future
researches.
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This study was based on a relatively
small sample due to the uniqueness of the
participants. In future research, there is a
need to reach a broader sample, preferably
from various countries in order to
strengthen the generalizability of the
results. Moreover, in future research, a
qualitative study should be conducted that
includes open format questionnaires and
in-depth interviews with women who suf-
fered sexual and=or physical abuse in order
to expand and clarify our understanding of
the common and differential effects of
these forms of trauma on victims.
In summary, the current research raises
a sensitive issue that is very complicated to
study. It is the first to investigate the men-
tal pain of women who have gone through
physical and=or sexual abuse, and it makes
a unique contribution to the theoretical
thinking about physical and=or sexual
abuse and their implications for women
who have experienced them. In addition,
practical insights are also to be gained from
the findings of the study in regard to the
differential treatment that should be pro-
vided for each group of victims.
AUTHOR NOTE
Inbar Kremer, Department of Manage-
ment, Bar Ilan University, Ramat Gan,
Israel.
ARCHIVES OF SUICIDE RESEARCH
I. Kremer et al.
Israel Orbach, Department of Psy-
chology, Bar Ilan University, Ramat Gan,
Israel.
Tova Rosenbloom, Department of
Management, Bar Ilan University, Ramat
Gan, Israel.
We are sad to report that Professor
Israel Orbach passed away in November,
2010.
Correspondence concerning this article
should be addressed to Inbar Kremer,
Department of Management, Bar Ilan
University, Ramat-Gan 52900, Israel.
E-mail: kremerinbar@gmail.com
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